MAT Program Application

Personal Information

Legal Name:

Preferred Name:

Former Names:

Birthdate:    Gender: |

Last 4 digits of your Social Security Number:

Current Address

Email:

Street Address:


City: State:      ZIP:

Telephone:

Permanent Address

Street Address:


City: State:      ZIP:

Telephone:

Please indicate your mailing address for all admission correspondence.

| |

Street Address:


City: State:      ZIP:

Use until:

Previous Education

List all colleges and universities where you have taken courses. Please have an official transcript mailed directly to the Admission Office at The College of Idaho from each institution. (If you are a graduate or current student of the College of Idaho, and have no outside coursework, this will not be necessary.)

Admission Office
The College of Idaho
2112 Cleveland Blvd.
Caldwell, ID 83605

1. Name of college / university:

Location:

Degree earned:

Attended (mm/yy - mm/yy):

 

2. Name of college / university:

Location:

Degree earned:

Attended (mm/yy - mm/yy):

 

3. Name of college / university:

Location:

Degree earned:

    Attended (mm/yy - mm/yy):

 

4. Name of college / university:

Location:

Degree earned:

Attended (mm/yy - mm/yy):

 
Entrance

I wish to apply for for admission to the program to begin classes:

(year / semester)